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Assessment of Glycemic Control by Continuous Glucose Monitoring, Hemoglobin A1c, Fructosamine and Glycated Albumin in Patients with End-Stage Kidney Disease and Burnt-Out Diabetes

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posted on 2023-12-12, 18:02 authored by Candice Y. Kaminski, Rodolfo J. Galindo, Jose E. Navarrete, Zohyra Zabala, Bobak Moazzami, Amany Gerges, Rozalina G. McCoy, Maya Fayfman, Priyathama Vellanki, Thaer Idrees, Limin Peng, Guillermo E. Umpierrez

Background. Patients with diabetes and end-stage kidney disease (ESKD) may experience “burnt-out diabetes”, defined as having a HbA1c <6.5% without antidiabetic therapy for >6 months.

Methods. This pilot prospective study assessed glycemic control by continuous glucose monitoring (Dexcom CGM), HbA1c, glycated albumin and fructosamine in patients with burnt-out diabetes (n=20) and without a history of diabetes (n=20).

Results. Patients with burnt-out diabetes had higher CGM-measured daily glucose, lower % time in range 70-180 mg/dL, higher % time above range >250 mg/dL, and longer duration of hyperglycemia >180 mg/dL (hours/day) compared to patients without diabetes (all p<0.01). HbA1c and fructosamine levels were similar; however, patients with burnt-out diabetes had higher levels of glycated albumin than patients without diabetes.

Conclusion. The use of CGM demonstrated that patients with burnt-out diabetes have significant undiagnosed hyperglycemia. CGM and glycated albumin provide better assessment of glycemic control than HbA1c and fructosamine in patients with ESKD.


Funding

RJG is partially supported by research grants from NIH/NIDDK P30DK111024 and 1K23DK123384-03. RJG received research support to Emory University for investigator-initiated studies from Novo Nordisk, Dexcom and Eli Lilly and consulting fees from Abbott Diabetes Care, Dexcom, Sanofi, Eli Lilly, Bayer and Novo Nordisk, outside of this work. PV is supported in part by NIH grant 1K23DK113241 and has received consulting fees from Mitre. GEU is partly supported by research grants from National Institutes of Health (NIH/NATS UL 3UL1TR002378-05S2) from the Clinical and Translational Science Award program, and from National Institutes of Health and National Center for Research Resources (NIH/NIDDK 2P30DK111024-06). GEU has received research support (to Emory University) from Bayer, Abbott and Dexcom, and has served in Advisory Boards for Dexcom and Glycare. RGM received support from NIDDK (K23DK114497; R03DK127010), National Institute on Aging (R01AG079113), PCORI (DB-2020C2-20306), and National Center for Advancing Translational Sciences (UL1TR002377). She also serves as a consultant to Emmi® (Wolters Kluwer) on developing patient education materials related to diabetes. CYK, JN, ZZ, BM, AG, TI, RGM, LP report no conflicts of interest relevant to this article. Dexcom provided CGM devices, a device reader, and adhesive patches to the study team. The Jacob’s Fund for Education provided the funds for the gift cards for the participants and the cost of research study.

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